OBJECTIVES: The presence of acne can significantly impact patients' health-related quality of life (HRQoL); however, the correlation between patient-reported HRQoL impairment and clinician-evaluated severity has been unclear. The objective of the study was to evaluate HRQoL in patients with different acne severity using generic, dermatology-specific and acne-specific instruments and investigate the correlation between clinical severity and HRQoL. DESIGN: Data for the cross-sectional survey were extracted from March 2017 to December 2018. The convenient sampling strategy was used to select participants. SETTING: The study was conducted at the Department of Dermatology, Qilu Hospital, Shandong University. PARTICIPANTS: A total of 1056 outpatients participated in the survey, and 962 patients were analysed in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The generic instrument (EuroQol 5-Dimensions 5-Levels, EQ-5D-5L), dermatology-specific instrument (Dermatology Life Quality Index, DLQI) and acne-specific instrument (Cardiff Acne Disability Index, CADI) were administered to assess HRQoL and the Global Acne Grading System was used to measure clinical severity. RESULTS: The mean health state utility (HSU) EQ-5D-5L score of 0.96 (SD: 0.06), a total DLQI score of 6.84 (SD: 4.88) and a total CADI score of 5.72 (SD: 2.81). Patients with moderate and severe acne showed greater impairment compared with patients with mild acne, as evidenced by significantly lower HSU scores (-0.017 and -0.066) and higher DLQI (1.457 and 2.043) and CADI scores (0.726 and 1.685). Clinical severity was weakly correlated with HRQoL scores for all acne severities (rs=-0.131 to 0.167). CONCLUSIONS: Acne is associated with significant HRQoL impairments, especially in terms of psychosocial functioning. It is very important to incorporate HRQoL assessment into clinical practice in future research, and dermatology-specific and acne-specific HRQoL instruments should be used in combination to assess the health status of acne patients.